Exercise Induced Bronchoconstriction

Publication Date: May 1, 2016

Key Points

Key Points

  • The major trigger for bronchoconstriction in a vulnerable subject is either water loss during periods of high ventilation or the addition of an osmotically active agent.
  • Exercise itself is not needed to cause bronchoconstriction, just the creation of a hyperosmolar environment.
    • The hyperosmolar environment leads to mast cell degranulation with release of mediators, predominately leukotrienes, but also including histamine, tryptase, and prostaglandins. In addition, eosinophils can also be activated, producing further mediators, including leukotrienes.
  • The water content of the inspired air, the level achieved and maintained during exercise, or both are the major determinants of exercise-induced bronchoconstriction (EIB).
  • EIB is frequently documented with asthma and reflects insufficient control of underlying asthma.
  • Elite athletes have a higher prevalence of EIB than seen in the general population, varying with the intensity of exercise and the environment.

Diagnosis

...agnosis...

...ment (SS)1: In asthmatic patients EIB ca...


...2: A diagnosis of EIB should be confirmed by dem...


...Evaluate EIB in elite athletes by using obj...


...standardized bronchoprovocation (exercise...


...: In subjects with no current clinical hi...


...n indirect graded challenge (eg, mannitol, if...


...: Perform an indirect challenge (e...


...e the ventilation reached and sustained during...


...form EVH as the preferred surrogate challenge f...


...n indirect graded challenge (eg, mannitol) resu...


...: To differentiate between EIB and...


...mine whether exercise-induced dyspnea a...


...13: Perform spirometry, as well as detailed p...


...Consider a diagnosis of exercise-induced anaphylax...


Treatment

Treatm...

...er to appropriate specialists (eg, cardiologi...

...16: Refer patients for psychological evaluation wh...

...egular office visits with patients because medic...


...2-Adrenergic Receptor Agonists...

...: Prescribe inhaled short-acting β2-ad...

...Prescribe a single dose of SABA, LABA, or both o...

...s in daily use of β2-adrenergic agents alone or...


...otriene Inhibito...

...21: Consider prescribing daily therapy with leukot...


...st Cell Stabilizers...

...prescribing inhaled cromolyn sodium an...


...CSs

...r prescribing ICSs in combination with other...

...rescribe daily LABAs with ICS therapy to...


...linergic Agents...

...prescribing inhaled ipratropium bromide for...


...rmacologic Therap...

...6: Prescribe pre-exercise warm-up for EIB becaus...

...with caution the recommendation of reduction of...


...petitive and Elite Athletes...

SS28: Treat athletes with EIB alone in a simila...


...igure 1. Algorithm for the Diagnosis, T...